MEDICARE: JAMIE LAWRENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1467243568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LAWRENCE

Provider Business Mailing Address
First Line	:	515 BELLE POINT DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-8275
Country	:	US
Telephone Number	:	847-505-6451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 MISTY MOUNTAIN RD APT 212
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-3947
Country	:	US
Telephone Number	:	847-505-6451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/26/2026

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